The validity of death certificate diagnosis of out-of-hospital sudden cardiac death (OOH-SCD) was studied among 108,676 30-to 74-year-old residents in 5 Minnesota communities using 6-year mortality data (1985 to 1990).

Among 4,244 tota deaths, location of death was listed on the certificate as out of hospital in 2,035 cases.

Of those, 91 1 were judged not to have OOH-SCD because they had actually n admitted to the hospital or were noncardiovascular deaths.

Among the remaining 1,124,254 were diagnosed as OOH-SCD using a thorough, physician-bas procedure that used clinical records, autopsy reports, and an informant (next-of-kin) interview.

We used only death certificate information to define OOH-SCD simply and inexpensively as ICD-9 code 427.5 (cardiac arrest) plus location of death listed as out-of-hospital, Compared with the physician diagnosis, sensitivity was only 24%, whereas specificity was 85%. When the definition of OOH-SCD was expanded to include ICD codes 410-414 (acute myocardial infarction and chronic coronary artery disease), sensitivity improved to 87%, whereas specificity became 66%. However, even with this higher sensitivity and specificity, only 27% of the cases labeled OOH-SCD by eath certificate agreed with the physician diagnosis. (...)